Polycythaemia following renal transplantation.

Polycythaemia has developed in 10 of 59 regularly reviewed patients with renal transplants surviving more than three months. The pathology of the raised haemoglobin level was heterogeneous. Three patients had a picture characterized by a normal red cell mass and reduced plasma volume. Seven patients had a raised red cell mass; in 3 of these this was associated with a period of abnormal liver function and fitted with the state of raised red cell mass in association with hepatic transaminitis. The remaining 4 patients form a unique, previously undefined group with no features to explain the underlying aetiology of the polycythaemia. The patients had a trouble-free post-transplant course with early establishment of graft function. It is proposed, from the data obtained from in vitro culture studies, that the early return of good renal function allows the erythroid compartment to expand in response to circulating erythropoietin. The establishment of an erythron of increased size allows for a persistently raised haemoglobin in the presence of normal erythropoietin levels.     

Significance of enteric gram-negative bacilli in the throat.

Pharyngeal micro-organisms of 131 Australian and Malaysian children and adults were compared by analysis of aerobic culture of throat swab specimens. Enteric Gram-negative bacilli were commonly isolated in small numbers from Malaysian adults whether they had sore throats (28%) or not (36%), but were detected in only 9% of Australian adults without sore throats and in only 12% and 4% of Malaysian children with and without sore throats respectively. In other respects microbiological findings were similar in the different groups of subjects studied. It is concluded that the pharyngeal carriage rate of enteric Gram-negative bacilli may differ substantially between different groups of normal individuals. Our findings also suggest that these micro-organisms do not have a pathogenic role in pharyngitis.     

Natural history of colonization with vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and resistant gram-negative bacilli among long-term-care facility residents.

OBJECTIVE: To determine the natural history of colonization with vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and resistant gram-negative bacilli among long-term-care facility (LTCF) residents. DESIGN: Observational cohort study. SETTING: A 355-bed LTCF with a ventilator unit and a subacute unit. PARTICIPANTS: Residents with colonization or infection with VRE, MRSA, or resistant gram-negative bacilli housed at the LTCF between December 1, 1999, and February 29, 2000. METHODS: Cultures of clinical and surveillance sites were performed at regular intervals. Charts were reviewed for clinical characteristics associated with clearance of colonization. Kaplan-Meier curves were constructed to analyze the number of days to clearance of colonization. RESULTS: Forty-nine residents had 65 episodes of colonization (27 VRE, 30 MRSA, and 8 resistant gram-negative bacilli). Eighteen (28%) of the episodes cleared. The clearance rate was 2.7 episodes per 1,000 person-days. Clearance occurred significantly more often with resistant gram-negative bacilli colonization compared with VRE or MRSA colonization (6 [75%] vs 12 [21%]; P = .007; relative risk, 4.17; 95% confidence interval, 1.26 to 11.8). There was a trend toward longer use of antimicrobial agents among residents with persistent colonization. Infections occurred most frequently with MRSA. The urinary tract was the most common site of infection. CONCLUSION: Among LTCF residents, colonization with resistant gram-negative bacilli is four times more likely to clear than colonization with VRE or MRSA. Performance of surveillance cultures at regular intervals may reduce the need for contact precautions for LTCF residents with resistant gram-negative bacilli colonization.     

临床常见革兰阴性杆菌的分离情况及耐药分析

目的 了解本地区2010年度临床常见革兰阴性杆菌的分离情况及耐药情况,指导临床合理应用抗菌药.方法 对2010年分离的革兰阴性杆菌进行分析,药敏采用K-B法进行.结果 2010年共计分离534株病原菌,其中革兰阴性杆菌323株,占60.5％.分离前3位分别是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌,分别为98株、77株、64株.其中大肠埃希菌产超广谱β-内酰胺酶68株,阳性率为68.4％,对头孢哌酮/舒巴坦、哌拉西林/三唑巴坦、亚胺培南、美洛培南的耐药率较低.41株克雷伯菌属细菌产超广谱β-内酰胺酶,阳性率为46.1％.铜绿假单胞菌及不动杆菌属对碳青霉烯类抗菌药耐药率较高.结论 本地区病原菌以革兰阴性杆菌为主,其中主要为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌;大肠埃希菌产超广谱β-内酰胺酶率较高.各类菌的耐药率均较高,因此应加强本地细菌的耐药监测,从而指导临床合理应用抗菌素.     

肝移植患者术后耐碳青霉烯类革兰阴性菌感染的影响因素分析

目的分析肝移植患者术后医院感染的流行病学特征及耐碳青霉烯类革兰阴性菌(CR-GNB)感染的影响因素,为术后感染防控提出科学依据。方法回顾性分析2017年1月-2018年6月四川大学华西医院肝移植手术患者188例的临床资料。采用1∶4配对病例对照研究,选取术后CR-GNB感染患者为病例组,共16例,未发生术后感染患者为对照组,共55例(其中9例为1∶3配对)。分析患者性别、年龄、抗菌药物使用情况、基础疾病等临床资料,归纳肝移植患者术后感染CR-GNB的影响因素。结果 188例肝移植患者,术后感染35例,感染率为18.62%。感染CR-GNB病原菌主要为耐碳青霉烯类的鲍氏不动杆菌(CRAB)和耐碳青霉烯类的肺炎克雷伯菌(CRKP),感染CR-GNB的患者不良预后率为62.50%,高于非感染患者9.15%(P<0.001)。抗菌药物联用与气管插管天数是肝移植术后患者感染CR-GNB的影响因素(P<0.05)。气管插管时间为肝移植术后患者感染CRAB的影响因素(P=0.040),但与CRKP感染无相关性。结论肝移植的感染率较高,其中CR-GNB感染将导致患者预后较差,临床应针对不同的感染影响因素采取合理的控制措施,以降低术后感染率。     

耐亚胺培南革兰阴性杆菌的变迁与临床分布

目的 调查耐亚胺培南革兰阴性杆菌的分离情况和临床分布.方法 收集2008年1月-2010年12月住院患者各种标本中分离出的病原菌,采用法国生物梅里埃公司的VITEK-2全自动微生物分析系统进行鉴定和药物敏感试验,结果用WHONET 5.4软件进行分析.结果 3年内共分离出耐亚胺培南革兰阴性杆菌株906株,其中2008年185株,分离率为15.7％,非发酵菌占93.0％;2009年361株,分离率为18.0％,非发酵菌占73.4％;2010年360株,分离率为18.1％,非发酵菌占81.9％,非发酵菌主要见于鲍氏不动杆菌、铜绿假单胞菌、金黄杆菌属、嗜麦芽寡养单胞菌等;肠杆菌科主要见于变形菌属、肺炎克雷伯菌、大肠埃希菌、肠杆菌属.结论 医院分离的耐亚胺培南菌株中非发酵菌一直占较大比例,且2009年出现的耐亚胺培南肠杆菌科比2008年明显上升,但2010年有所下降.     

Mycoplasma pulmonis infection of the murine oropharynx protects against subsequent vaginal colonization.

Intranasal inoculation of 12 young adult mice (strain TO) with Mycoplasma pulmonis protected all of them against vaginal colonization when they were challenged intravaginally 60 days later with the same mycoplasmal strain. In contrast, all 15 mice without a respiratory infection became colonized vaginally (geometric mean titre [GMT] 4.6 x 10(6) colour-changing units [c.c.u.]) when challenged in the same way. The GMT of serum antibody, measured by a microimmunofluorescence technique, prior to challenge was 200 and 8 for the oropharyngeally infected and unexposed mice, respectively. The GMT of antibody in vaginal washings from the two groups was 6 and 3, respectively. All four nude BALB/c mice were susceptible to vaginal colonization (GMT 5.6 x 10(6) c.c.u.) after oropharyngeal infection (GMT 5.1 x 10(4) c.c.u.) resulting from intranasal inoculation, as were all six nude mice (vaginal GMT 1.4 x 10(7) c.c.u.) that had not been inoculated intranasally. In contrast, all ten of their immunocompetent counterparts were resistant to vaginal colonization after oropharyngeal infection (GMT 1.3 x 10(3) c.c.u.), whereas all nine such mice that had not been infected oropharyngeally were susceptible to vaginal colonization (GMT 7.6 x 10(6) c.c.u.). These results show the important role that a respiratory infection has in protecting the vagina against colonization and that protection is dependent on a functioning T-lymphocyte system.     

Resistance to imipenem among selected gram-negative bacilli in the United States.

OBJECTIVES: Identification of imipenem resistance among selected gram-negative bacilli, especially Pseudomonas aeruginosa and Enterobacter species. METHODS: We analyzed 1986-1990 National Nosocomial Infection Surveillance (NNIS) data from 3,316 P aeruginosa isolates and 1,825 Enterobacter species isolates for which susceptibility results to imipenem were reported. RESULTS: For P aeruginosa, 11.1% of the isolates were resistant to imipenem; 16.1% were either intermediate-susceptible or resistant to the drug. A logistic regression model found that resistance was more common among P aeruginosa isolated from the respiratory tract, patients in intensive care units, and in teaching hospitals. Additionally, resistance to imipenem increased by 25% in teaching hospitals from 1986-1988 to 1989-1990. For Enterobacter species, 1.3% of the isolates were resistant to imipenem; 2.3% were either intermediate-susceptible or resistant to the drug. However, imipenem resistance for these isolates did not differ between the two periods and was not more common in patients in an intensive care unit or infections at any specific site. CONCLUSIONS: The frequency of resistance to imipenem is greater among P aeruginosa than among Enterobacter species. Resistance to imipenem among the P aeruginosa isolates is more common from strains isolated from patients with nosocomial infections in an intensive care unit, from the respiratory tract, and from teaching hospitals. Resistance appears to be increasing among nosocomial P aeruginosa isolated in teaching hospitals.     

The identification of gram-negative anaerobic bacilli isolated from clinical infections.

Gram-negative anaerobic bacilli isolated from specimens submitted to the routine diagnostic bacteriology laboratory and regarded as significant pathogens were identified by conventional bacteriological tests; 399 strains isolated from 356 specimens submitted from 332 patients were studied and most were readily identified by the results of a combined set of morphological, biochemical, tolerance and antibiotic disk resistance tests; B. fragilis has particular pathogenic potential and was the commonest species isolated, accounting for greater than 50% of strains. The next commonest was B. asaccharolyticus with 55 strains, and 16 other species or groups were represented by smaller numbers. Many (68%) were from infections related to the gastro-intestinal tract, but there were significant numbers from infections of the male and female genito-urinary tracts, the head, neck and central nervous system and from a variety of soft tissue infections. Most infections were mixed, and a pure culture of a Bacteroides sp. was obtained from only 26% of infections; two or more strains of Bacteroides were recovered from 55 infections. The specific identification of Bacteroides may help the bacteriologist to judge the significance of laboratory findings, influence the patient''s management and prognosis and help determine the source of infection.     

革兰阴性杆菌的分布及耐药性监测

目的 了解2010年医院住院患者感染性标本中分离的革兰阴性杆菌的构成比及耐药特征,为临床选择抗菌药物提供实验室依据.方法 病原菌培养及鉴定按照《全国临床检验操作规程》,采用常规方法进行;药敏试验采用CLSI推荐的K-B法.结果 683株革兰阴性杆菌中铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌、嗜麦芽寡养单胞菌占前5位,分别占38.8％、19.8％、17.4％、6.0％、4.1％;革兰阴性杆菌对常用抗菌药物大多数呈现多药耐药趋势,其中铜绿假单胞菌和鲍氏不动杆菌对亚胺培南和美罗培南的耐药率达22.6％～51.2％.结论 临床医师应注重病原菌耐药性的监测,根据病原菌类型及耐药特征合理选择抗菌药物.     

Aerobic gram-negative pharyngeal bacilli of adult Ethiopians: carrier rates and antibiograms.

One thousand pharyngeal swab specimens were processed for aerobic culture to determine the carriage rate of Gram-negative bacilli (GNB). The isolates were identified and their sensitivity determined to 11 antibacterial drugs following standard techniques. Similar pharyngeal carriage rates of GNB were found among the various groups of healthy subjects. Patients had higher colonization rates (27%) than healthy subjects (16%). The increase in prevalence of GNB seemed to be associated with underlying diseases and duration of hospitalization. Klebsiella (36%) was the most frequent genus amongst the 215 isolates of GNB followed by pseudomonas (13%), enterobacter (13%) and acinetobacter (10%). Others were less frequently isolated. Over 70% of all isolates were resistant to ampicillin (79%) and carbenicillin (72%); 55, 45 and 43% were resistant to cephalothin, tetracycline and streptomycin, respectively. The great majority of the strains were sensitive to the remaining six drugs. The hospital isolates were more resistant than the non-hospital isolates to most drugs tested. The hospital strains were also more often multiply resistant (89%) than the non-hospital strains (60%). Sixty-five different resistance antibiograms of 1-10 drugs were observed among 191 strains. More varied types of antibiograms were observed among hospital strains. The high frequency of multiple drug resistance of the isolates is an indication of the extensive use of antibacterial drugs, indicating the need for a policy for judicious use of drugs.     

Hospitalizations for cytomegalovirus disease after renal transplantation in the United States

PURPOSE: Risk factors, sites, and mortality of hospitalized cytomegalovirus (CMV) disease in renal transplant recipients have not been studied in a national population. METHODS: Therefore, 33,479 renal transplant recipients in the United States Renal Data System from 1 July 1, 1994 to June 30, 1997 were analyzed in an historical cohort study of patients with a primary discharge diagnosis of CMV disease (ICD9 Code 078.5x). RESULTS: Renal transplant recipients had an incidence density of hospitalized CMV disease of 1.26/100 person years, and 79% of hospitalizations for CMV disease occurred in the first six months post transplant. The leading manifestation of hospitalized infection was pneumonia (17%). In logistic regression analysis controlling for transplant era, pre-transplant dialysis > or = 6 months, maintenance mycophenolate mofetil (MMF) therapy, and allograft rejection, but not induction antibody therapy, were significantly associated with hospitalized CMV disease. Compared with recipients with negative CMV serology (R-) who had donor kidneys with negative CMV serology (D-), D+/R- had the highest risk of hospitalization for CMV disease [adjusted odds ratio (AOR) 5.19, 95% confidence interval (CI) 3.89-6.93] followed by D+/R+ recipients, whereas D-/R+ were not at significantly increased risk. In Cox Regression analysis the relative risk of death associated with hospitalized CMV disease was 1.32 (95% CI 1.02-1.71). CONCLUSIONS: Even in modern era, renal transplant recipients were at high risk for hospitalizations for CMV disease, which were associated with decreased patient survival. Current prophylactic measures have apparently not reduced the high risk of D+/R- recipients. Prolonged pre-transplant dialysis and maintenance MMF should also be considered risk factors for hospitalized CMV infection, and prospective trials of prophylactic antiviral therapy should be performed in these subgroups.     

临床分离革兰阴性杆菌分布与耐药特征

目的 分析2005、2009年哈尔滨市3所医院临床分离菌株分布特征.方法 收集2005、2009年革兰阴性杆菌,采用API20和常规生化反应进行鉴定.结果 2005年收集革兰阴性菌1172株,主要为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、阴沟肠杆菌和鲍氏不动杆菌,其构成比分别占34.22％、25.43％、22.35％、5.97％、5.21％;2009年收集2188株,主要为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌和阴沟肠杆菌,其构成比分别占30.85％、20.89％、19.83％、12.89％、8.27％;2005年铜绿假单胞菌及鲍氏不动杆菌对环丙沙星的耐药率分别为43.1％和9.8％,而2009年分别为98.5％和42.5％;肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌及阴沟肠杆菌对亚胺培南和美罗培南的耐药率为0～3.3％,而铜绿假单胞菌对亚胺培南和美罗培南的耐药率为22.6％～31.0％;2009年肺炎克雷伯菌耐药率与2005年相比呈下降趋势.结论 感染症菌群分布发生变化,肺炎克雷伯菌检出率呈上升趋势,抗菌药物的耐药状况因时而异.     

医院常见革兰阴性杆菌的分布及耐药性分析

目的通过分析医院患者中常见革兰阴性杆菌的种类、分布及耐药性,指导临床合理应用抗菌药物。方法收集2011年1月-2011年12月临床分离的主要革兰阴性杆菌,采用常规方法或ATB-Expression半自动微生物系统及配套进行菌株鉴定与药物敏感性测定,用WHONET5软件进行数据统计分析。结果检出的2 869株革兰阴性杆菌中,检出前5位的科室有成人重症监护病房、儿科、烧伤整形科、呼吸科及儿科重症监护病房,分别是487、278、230、194株及151株;最常见的依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌;大肠埃希菌对常用的喹诺酮类、氨曲南及头孢类耐药性较高,对亚胺培南、美罗培南、阿米卡星均较敏感,耐药率均<10.0%。结论充分认识细菌耐药特点,动态监测医院常见革兰阴性菌分布及耐药性变迁情况,对医院各科正确合理应用抗菌药物、提高疗效及减少耐药菌的产生具有重要的临床意义。